大脑半球离断术治疗儿童难治性癫痫的疗效分析  

Treatment efficacy of hemispherotomy for drug-resistant epilepsy in children

作　　者：许新科 谢艳平 李军亮 陈程 郑娅启 林锦荣 袁宏耀 李方成 Xu Xinke;Xie Yanping;Li Junliang;Chen Cheng;Zheng Yaqi;Lin Jinrong;Yuan Hongyao;Li Fangcheng(Department of Neurosurgery,Guangzhou Women&Children's Medical Center,Guangzhou 510120,China)

机构地区：[1]广州市妇女儿童医疗中心神经外科,广州510120

出　　处：《中华小儿外科杂志》2022年第2期103-107,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的总结大脑半球离断术治疗儿童半球性病变所致难治性癫痫的临床经验。方法收集广州市妇女儿童医疗中心神经外科2016年1月至2019年12月采用大脑半球离断术治疗儿童半球性病变所致难治性癫痫29例,其中,男19例,女10例,年龄3个月至6岁,平均年龄20.52个月,收集相关临床资料如性别、年龄、发作类型、影像学、脑电图、病理结果等,详细介绍手术方法,并对其进行随访以了解癫痫控制效果及并发症。结果29例患儿均经过详尽的术前评估并接受大脑半球离断术,共施行手术31人次,其中2例因术后离断不彻底行二次手术后癫痫发作缓解。术后病理提示皮质发育畸形14例,符合斯德奇-韦伯综合征(Sturge-Weber Syndrome,SWS)的9例,脑软化5例,结节性硬化1例。术后感染10例,经过抗感染治疗后好转,脑积水行脑室腹腔分流术2例,无手术死亡病例。除了1例患儿于术后半年因接种疫苗过敏死亡,其他所有患儿均得到有效随访,随访时间为3个月至4年,平均23.20个月。按Engel预后分级判断疗效,EngelⅠ级21例(75.00%),Ⅱ级2例(7.14%),Ⅲ级5例(17.86%),目前已停药3例,术后患儿精神运动发育较术前均有明显改善,对侧肢体肌力和术前相仿,远端精细运动差。结论相比传统的解剖性大脑半球切除术,大脑半球离断术能达到良好的控制癫痫效果,而且术后并发症大大减少,尤其适用于儿童半球性病变所致难治性癫痫。Objective To summarize the management experience of hemispherotomy for pediatric drug-resistant epilepsy caused by hemispheric lesions.Methods From January 2016 to December 2019,retrospective analysis was performed for 29 children of drug-resistant epilepsy caused by hemispheric lesions undergoing hemispherotomy.There were 19 boys and 10 girls with an average age of 20.52(from 3 to 72)months.The relevant clinical data of gender,age,seizure type,imaging studies,EEG and pathological results were collected.We introduced the surgical methods in detail,and followed up to understand the effect of epilepsy control and complications.Results Hemispherotomy was performed after thorough preoperative evaluations.Among a total of 31 operations,2 cases were relieved after reoperation for incomplete dissection.Postoperative pathology revealed malformations of cortical development(MCD,n=14),Sturge-Weber syndrome(SWS,n=9),encephalomalacia foci(n=5)and tuberous sclerosis(n=1).Ten cases of postoperative infection improved after antibiotic treatment and another two cases of hydrocephalus underwent ventricular-peritoneal shunt.Except for one mortality due to vaccination allergy at Month 6 postoperatively,the remainders were followed up effectively.The follow-up period was 23.20(3-48)months.According to the prognostic classification of Engel,the clinical grade wasⅠ(n=21,75.00%),Ⅱ(n=2,7.14%)andⅢ(n=5,17.86%).Three cases were discontinued and postoperative psychomotor development improved.And contralateral extremity muscle strength stabilized and distal fine movement was poor.Conclusion As compared with traditional anatomical hemispherectomy,hemispherotomy may achieve an excellent efficacy of controlling epilepsy and lowering postoperative complications,and it is especially suitable for pediatric drug resistant epilepsy caused by hemispheric lesions.

关 键 词：癫痫 大脑半球切除术 儿童 

分 类 号：R726.5[医药卫生—儿科]